The Most Commonly Asked Breast Augmentation Questions, Answered

When it comes to breast augmentation, there are dozens of nuances that allow surgeons to customize procedures for their patients. This, however, also leaves room for dozens of questions because the procedure isn’t one-size-fits-all or black and white. But, when performed by a qualified, board-certified plastic surgeon, it can be extremely safe, satisfying and life-changing. These are the top questions patients ask about breast augmentation, so you can take note if you’re considering it, whether you’re already in the consultation phase, or just doing research.

1. Are silicone implants safe?

“Yes,” says San Diego plastic surgeon Larry Pollack, MD. “A 10-year study done in the 1990s and early 2000s looked at the incidence of medical diseases such as lupus, scleroderma, rheumatoid arthritis, and other autoimmune diseases and found no difference between women with and without silicone breast implants. That being said, they can rupture, primarily due to trauma, and can cause local breast problems such as lumps or lymph node enlargement if present for a long time.”

2. Can I use breast implants instead of getting a breast lift?

“Implants do not lift breasts,” says Palo Alto, CA plastic surgeon David Boudreault, MD. “Whether through breastfeeding or weight loss, breasts can lose volume and ultimately sag. After breastfeeding, a mother can undergo a process called ‘involutional deflation,’ which can leave the breasts feeling empty and smaller than prior to pregnancy. If there is no sag in the breasts, then an implant can be used to restore the lost volume. If the breasts require a lift, then this is because the nipple-areolar complex (NAC) has fallen to or below the inframammary fold. Ultimately we are not talking about a breast lift, but rather a NAC repositioning. Although an implant successfully addresses breast size, we need to make sure that the NAC is positioned correctly on the breast for an optimal aesthetic outcome.”

3. Will my augmentation look natural?

“Natural is such a vague request, but this generally means having a gentle slow from the décolleté to mid-breast,” Dr. Boudreault. “Any ’roundness’ in the upper breast is considered fake. Achieving a natural look comes down to choosing an implant that fits your body. When taking your body measurements into consideration and choosing the appropriate type
of surgery, breast augmentation will look very natural. There are many ways to help determine the appropriate size, ranging from simple silicone sizers in the clinic to simulation software that can predict a surgical outcome. I recommend my patients use a variety of techniques to estimate the desired breast size, then the appropriate implant dimensions can be selected to achieve this result. Although the most common regret is going too small, I’ve found that patients can deal with this issue more easily than going too large. I frequently say, ‘It’s harder to hide them than make them look larger.’ Also, having large breasts can make a woman look heavier in professional clothing, which is something that is often not considered during a breast augmentation.”

4. What is the best way to make sure I get the look I want?

“I don’t think stuffing an implant in a bra is useful because it doesn’t mimic the real look and feel of the implant inside the body,” Dr. Pollack says. “I prefer patients look at before-and-after pictures online: Many plastic surgeons, including me, have a lot of pictures of different body types with different breast anatomy, and looking at photos is the best way for the patient and I to be on the same page. I take the selected photos into the OR so that I can match the desired look as closely as possible.”

5. Are there different implant shapes?

“The most commonly used implants are round, but they come in different profiles: low profile, moderate projection, high projection, and ultra-high projection,” Dr. Pollack explains. “The one we use depends on the look that the patient wants: natural, slightly round on top, or obvious! Most surgeons no longer use ‘teardrop-shaped’ implants because of the texturing on the shell.”

6. Why did the FDA place a black box warning on implants?

“Silicone gel implants have a long history of patients blaming them for their illness, but specifically, the FDA issued these warnings: 1.) Breast implants don’t last a lifetime. 2.) Complications can occur with breast implants, and the risks increase over time. 3.) Breast implants may be associated with a type of cancer and other symptoms,” says Dr. Boudreault. “In the 1990s, silicone gel implants were removed from the market to perform a 10-year clinical trial looking at whether or not silicone gel implants led to auto-immune diseases in women. The results of that study showed conclusively that the implants did not cause auto-immune disease. Despite this, women continue to seek implant removal to help with specific symptoms that can’t be explained or resolved with standard medical treatment. We refer to this as breast implant illness (BII). Additionally, we have seen an association between silicone gel implants and Anaplastic Large Cell Lymphoma (BIA-ALCL), which, although rare, has been seen in patients with gel implants.

Based on a review of the reported cases (less than 1,000 worldwide), there has been only one case in the smooth gel implant.  Currently, BIA-ALCL has been associated with a certain type of textured silicone gel device, but no conclusive cause and effect have been determined. All implants have a warranty that covers issues with implants, but there is no recommended timeline to remove or replace the implants. They are not considered a lifetime device, but the removal or replacement is dependent on patient preference or a thorough discussion with your plastic surgeon.”

7. What is breast implant illness?

“Breast implant illness is thought to be a reaction to the implants as a foreign body reaction that can cause fatigue, muscle aches, depression, hair loss, dry eyes, and other illnesses,” explains Dr. Pollack. “There is still a lot of controversy regarding the association of implants with those symptoms, and many women, but not all, who have their implants removed because of BII do not get better in the long-term.”

8. Do I have to replace my implants every 10 years?

“No,” says Dr. Pollack. “Only if you have a problem, or are having another breast procedure 10 years later, such as a lift. It’s not mandatory if the implants are still OK, but it is recommended.”

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